Introduction

NHSScotland routinely collects a vast array of data from healthcare processes. The analysis of these data can provide invaluable insight into the behaviour of these healthcare processes.

Statistical Process Control (SPC) techniques, when applied to measurement data, can be used to highlight areas that would benefit from further investigation. These techniques enable the user to identify variation within their process. Understanding this variation is the first step towards quality improvement.

There are many different SPC techniques that can be applied to data. The simplest SPC techniques to implement are the run and control charts. The purpose of these techniques is to identify when the process is displaying unusual behaviour.

The tutorial guide, which is available on the Clinical Indicators Website, provides an introduction to the application of run charts and control charts for identifying unusual behaviour in healthcare processes. SPC techniques are a tool for highlighting this unusual behaviour. However, these techniques do not necessarily indicate that the process is either right or wrong ? they merely indicate areas of the process that could merit further investigation.

The tutorial guide is also an ideal accompaniment to the Excel based Control Chart Tool which is downloadable free of charge. This is also available of the Clinical Indicators Website (please see links below).

www.indicators.scot.nhs.uk/SPC

History of SPC

1928 saw the introduction of the first Statistical Process Control (SPC) Charts. Commissioned by Bell Laboratories to improve the quality of telephones manufactured, Walter Shewhart developed a simple graphical method ? the first of a growing range of SPC Charts.

Understanding the causes of variation within an industrial process proved indispensable as actions could be taken to improve process and output. In the 1950?s, with the effective use of SPC, Deming converted post war Japan into the world leader of manufacturing excellence.

This approach is increasingly being applied in healthcare by thinking of healthcare systems as processes. As well as providing a basis for quality improvement within healthcare, SPC Charts also offer alternative methods of displaying data.

http://www.indicators.scot.nhs.uk/SPC/References.html

Training and Workshops

The Clinical Indicators Support Team (CIST) has been offering help and advice on SPC Charts to NHSScotland staff and beyond by means of workshops, training days as well as more informal meetings since the beginning of 2001.

It was at this time that Mohammed A Mohammed published one of the first papers looking at the applications of SPC Charts in Healthcare. At the end of 2001, in collaboration with CIST, he held a workshop detailing these applications at the Royal College of Surgeons.

This was the start of what is now over five years of CIST promoting SPC charts throughout NHSScotland.

The following year CIST launched two further workshops:

    An Introduction to Run Charts and Control Charts - October 2002.

    Using Run Charts and Control Charts to Monitor Quality in Healthcare - December 2002.

The use of SPC Charts has gathered a huge amount of interest throughout NHSScotland. Their ease of use and simplicity to construct has enabled their implementation in many aspects of healthcare.

CIST have aided in the promotion of SPC Charts by offering support to the health service.

CIST also offer a free downloadable web tool on their website which enables customers to create and interpret SPC Charts at the touch of a button.

http://www.indicators.scot.nhs.uk/Workshops/SPC.html

Projects using SPC

A variety of projects within the Information Services Division (ISD) are now using SPC Charts to monitor and display data. Most notably the projects and audits within the Quality Improvement/Clinical Governance Programme (QICGP).

The QICGP has been using SPC Charts within reports such as the Surgical Profiles Reports, Scottish Arthroplasty Project Reports and Scottish Hip Fracture Audit Reports.

More Information on these projects can be found in the projects page as well as the Clinical Outcome Indicators Website - www.indicators.scot.nhs.uk